Transparency , Accountability and Rule of Law

Health of the budget

Contrary to its claims, the Punjab government has reduced the health budget by Rs5 billion, which is a worrying concern. In its recently announced annual budget, for the fiscal year 2019-20, the Punjab government allocated Rs279 billion for health sector. While the government claimed that the allocation budget was up by 20 percent from the current fiscal year (which ends June 30), the fact is that the caretaker government had allocated Rs284 bn for health.

To put it in other words, the Pakistan Tehreek-e-Insaf led provincial government has reduced the health budget by Rs5 bn. Moreover, some important healthcare programmes seem to have been overlooked completely.

The highlights of the health budget include setting up a children’s hospital in Bahawalpur. Besides, Rs3.5 bn has been assigned for revamping the Tehsil Headquarter (THQ) and District Headquarter (DHQ) hospitals across the province. Rs1.5 bn has been allocated for provision of free medicines to patients of hepatitis; at least eight hospitals are being set up in Layyah, Mianwali, Lahore, Rahim Yar Khan, Rawalpindi, Dera Ghazi Khan, and Multan; and Rs12 bn is to go to free drugs and healthcare services. The Sehat Card programme is also to be expanded to 36 districts of Punjab, with an allocated budget of Rs2 bn.

The Punjab government manages a large number of health related facilities, be it teaching, research or tertiary. There are six universities, 11 colleges, 46 tertiary health facilities, 45 nursing colleges/schools, and numerous other institutions for allied services. As far as the primary and secondary healthcare facilities are concerned, Punjab boasts 32 District Headquarter Hospitals, 126 Tehsil Headquarter Hospitals, 316 Rural Health Centres (RHCs) and 2,506 Basic Health Units.

“Until recently, most of these facilities were poorly funded and managed, and lacked adequate staff and facilities,” says Mukhtar Ahmed Ali, a health expert and the founder director of Centre for Peace and Development Initiatives (CPDI).

Ali also speaks of presenting a Shadow Development Budget for the Punjab’s health sector. “Unfortunately, the FY2019-20’s health budget doesn’t offer much to improve the current health facilities,” he adds.

It is pertinent to mention here that in its manifesto for 2018-23, the PTI had promised to “ensure universal health coverage and enhance the focus on primary healthcare, while upgrading secondary and tertiary facilities; to upscale the Sehat Insaf Card Programme across Pakistan; double the size of the Lady Health Workers (LHWs) programme; increase the number of 24/7 BHUs and RHCs, equipped with basic package of services; establish training institutes for nurses and paramedical staff nationwide; upgrade secondary care facilities; and build state-of-the-art hospitals in major urban centres.”

For Ali, “Factually, the first health budget is not a true reflection of the promises made by the PTI in its manifesto. With the allocation of Rs3.5 billion a large number of primary and secondary health facilities would remain under-resourced.

“It is important to allocate sufficient budget to set up more facilities across the regions, to further improve the quality of services and management in existing facilities, and to lessen the burden at the tertiary level which is not only concentrated in large cities but also inaccessible for the poor or those based in remote areas.”

Apart from the regular facilities, the Punjab government is managing a number of disease prevention programmes aimed at controlling different types of ailments such as Hepatitis, AIDS, Tuberculosis (TB), Integrated Reproductive, Maternal, Newborn & Child Health (IRMNCH), and the Nutrition, Malaria, Immunisation and Infection Control Program.

“Preventive healthcare strategies must be a priority area for any government,” says Dr Ashraf Nizami, Central President, Pakistan Medical Association (PMA), “because the schemes are designed to avert any incidence of diseases at the primary level.

“Reduction in health budget is a matter of concern,” he declares.

The government has allocated Rs40 bn for setting up new hospitals and upgrading the Children’s Hospital, Lahore, to the status of a medical university. The PMA appreciates the announcement of establishing new hospitals that are among the long-awaited projects, but Dr Nizami says the allocated funds for the new hospitals are insufficient. “This means that the government has decided not to complete these in one year’s time. Secondly, no amount is allocated to enhancing the capacity of the existing six medical public universities.

“The budget for purchasing medicines has also been ignored by the government,” he adds. “Likewise for the strength of nurses and paramedical staff at the district level. There is disappointment when you look at the paltry earmarking in the budget for scientific research and development programmes of healthcare.”

Health experts bracket the issue of safe drinking water supply with the health sector, as it causes various diseases some of which can also cause an epidemic situation. The Punjab government has allocated Rs8 bn for supply of clean drinking water, and Rs8.1 bn for rehabilitation of 662 dysfunctional rural water supply schemes. Mukhtar Ahmed Ali considers it an inadequate amount.

According to the data provided by the CPDI, one of the major health challenges continues to be the large percentage of births that are not attended by skilled workers. Lack of maternity services and child healthcare units at the primary level is the main cause of the high rate of maternal and child mortality in Pakistan. The new budget offers nothing to support such programmes.

In 2015, the Sustainable Development Goals (SDGs) were adopted by nations to end poverty, protect our planet, and to ensure that people enjoy peace and prosperity. Of the 17 agreed goals, Goal 3 concerns good health and well-being. The government of Pakistan was among the first few countries to adopt the SDGs as their national goals.

An expert on SDGs, and the Chief Executive of Awaz Centre for Development Services (CDS) Zia Ur Rehman says that after the 18th Constitutional Amendment in 2010, under the international commitments, 99 indicators of the SDGs shall be implemented by the provincial government. “Some of the major health targets for the SDG 3 include reducing the global maternal mortality ratio to less than 70 per 100,000 live births, by the year 2030; ending preventable deaths of newborns and children under five years of age; with all countries aiming to reduce the neo-natal mortality to at least as low as 12 per 1,000 live births and under-five mortalities to at least as low as 25 per 1,000 live births; combating AIDS, TB, malaria, and neglected tropical diseases as well as water-borne diseases like hepatitis, and other communicable diseases; reducing by one-third premature mortality from non-communicable diseases through prevention and treatment; promoting mental health and well-being; giving access to quality, essential health-care services and safe, effective, and affordable essential medicines and vaccines for all.”

The allocation of budget and related policy should be a true reflection of the commitments made by the government at national and international levels, Rehman adds. “It is evident that the current health budget like previous ones is opposite to the roadmap offered on ‘National Priority Targets’ in 2016, to implement the Goal 3.”